3. Roecker - Ventilation Devices

Question 1

When is ventilation used?

Answer 1

Acute respiratory failure

Adjuncts to other therapies or diagnostic procedures to avoid complications

Question 2

What are the two categories of acute respiratory failure?

Answer 2

1. Hypoxemic - O2 sats is 50mmHg

Question 3

What are the 3 goals of therapy of acute respiratory failure?

Answer 3

1. Decrease metabolic burden of breathing
2. Prevent respiratory muscles fatigue
3. Keep patient alive

Question 4

What are 5 causes of hypoxemic respiratory failure?

Answer 4

1. Acute respiratory distress syndrome
2. Heart failure w/ pulmonary edema
3. Infections causes
4. Procedure complications
5. Trauma

Question 5

What are 3 causes of hypercarbic respiratory failure

Answer 5

1. Coma
2. COPD exacerbations
3. Neuromuscular diseases

Question 6

Ventilation is adjunctive therapy for…

Answer 6

1. Increased intracranial pressure
2. Endoscopy
3. Gastric lavage
4. Prevention of respiratory failure during critical illness

Question 7

When is non-invasive ventilation used?

Answer 7

1. Effective in pts w/ COPD exacerbations

2. Complications of pneumonia or tracheolaryngeal trauma avoided

Question 8

What are 4 contraindications of non-invasive ventilation?

Answer 8

1. Cardiac/respiratory arrest
2. Severe encephalopathy
3. Hemodynamic instability
4. High-risk for aspiration

Question 9

When is a pocket mask used?

Answer 9

For mouth to mouth resuscitation in non-breathing patients in a code situation

Question 10

When is a bag-valve mask used?

Answer 10

To provide oxygen/air to non-breathing patient in a code situation
The squeeze bag to give air to an unresponsive pt

Question 11

What are the 2 airway adjuncts? What is their purpose?

Answer 11

1. Oropharyngeal airway (OPA)
2. Nasopharyngeal airway (NPA)
   Opens the airway to get air down to lungs, does not involve putting a tube down the pts throat

Question 12

What dose an oropharyngeal airway do?

Answer 12

Keeps tongue out of the way and gets air down to the lungs

Question 13

What does the nasopharyngeal airway do?

Answer 13

Goes up though the nose, then down though the nasal passage to get air in the body

Question 14

What are the 4 advanced airways?

Answer 14

1. Laryngeal mask airway
2. Combitube
3. Endotracheal tube
4. Tracheostomy tube

Question 15

What is a laryngeal makes airway?

Answer 15

Inserts to a specific depth and inflate a cuff to isolate air down trachea and not esophagus

Question 16

What is a combitube?

Answer 16

Two separate tubes, a blind insertion, then inflate both cuffs.
If tube ends up in esophagus, balloon blocks off esophagous
If tube ends up in tranches, good!

Question 17

What is an endotraceal tube?

Answer 17

Similar to a combitube, but requires visualization of vocal cords with laryngoscope - most commonly seen for pts on long term ventilation.
Think of Grey’s Anatomy

Question 18

What is a tracheostomy tube?

Answer 18

A surgical procedure is needed, bypass the pharynx and then directly ventilate

Question 19

What kind of air is needed for mechanical ventilation?

Answer 19

Conditioned, warmed, oxygenated, and humidified air

Question 20

What is the goal of mechanical ventilation?

Answer 20

Optimize oxygenation while avoiding damage to lung tissue, over stretching and ventilation-induced lung injury

Question 21

How is total volume used in ventilation?

Answer 21

Size of each ventilation, amount of air put into the lungs

Question 22

What is ventilator rate?

Answer 22

Timing of each ventilating, providing the pt with a respiratory rate

Question 23

What is FIO2?

Answer 23

Fraction of inspired oxygen; amount of oxygen given to the pt to keep their O2 levels up

Question 24

What is PEEP level?

Answer 24

Positive end-expiratory pressure - enough pressure to keep lungs open at end of expiration
Used to keep lungs inflated so oxygen exchange can occur in blood

Question 25

What is I/E ratio?

Answer 25

Inspiratory-to-expiratory time ratio; how much time going in vs how much time going out. Usually 1:2

Question 26

What is VE?

Answer 26

Minute ventilation - product of tidal volume and ventilator rate

Question 27

What is ABG?

Answer 27

Acid-blood passes to measure PaO2 and PaCO2

Question 28

What are the 6 ventilator modes?

Answer 28

1. Assist control (AC) 2. Intermittent mandatory ventilation 3. Pressure support ventilation (PSV) 4. Pressure control ventilation (PCV) 5. Inverse ratio ventilation (IRV) 6. Continuous positive airway pressure (CPAP)

Question 29

When is mechanical ventilation needed?

Answer 29

When an individual cannot adequately oxygenate with their own respirations

Question 30

When is assist control ventilation used?

Answer 30

Most often used when a pt is first started on ventilation.

Question 31

How does assist control ventilation work?

Answer 31

Ventilation is initiated by patient or the machine if specified has passed. The rate and volume is defined by the clinician.

Question 32

What are some A/E of assist control ventilation?

Answer 32

Hyperinflation or respiratory alkalemia if inappropriately monitored

Question 33

How does intermittent mandatory ventilation work?

Answer 33

Synchronous IMV coordinates the mandatory breaths to the patient breath (if present). Only a pre-set number of breaths will be assisted and controlled

Question 34

How does pressure support ventilation work? Who tolerates this the best?

Answer 34

Pressure from ventilator is only provided when an inspiratory effort is seen from the patient. Well tolerated by those being weaned off of ventilators.

Question 35

How does pressure control work. When is it to be used?

Answer 35

Works by allowing a specific amount of pressure on inspiration. Good to use where limited pressures are necessary and pt needs peak airway pressures to stay low.

Question 36

How does inverse ratio ventilation work? When it is used?

Answer 36

Uses longer inspiratory time and shorter expiratory time, will change the I/E ratio. Used to potentially open collapsed alveoli when augmented w/ appropriate PEEP levels.

Question 37

What is continuous positive airway pressure?

Answer 37

Constant pressured provided only on inspiration to keep the pts airway open.

Question 38

What are 4 potential complications from mechanical ventilation?

Answer 38

1. Barotrauma - pressure and volume causing dissenting or damage to lung tissue 2. Nosocomial pneumonia - hospital acquired pneumonia 3. Stenosis - trauma from incubation 4. Decondition of respiratory muscles - loose respiratory muscle tone if on ventilation for too long, will need to wean lungs off ventilation

Question 39

What is a spontaneous breathing trial and when is it utilized?

Answer 39

For pts who are potentially ready to be weaned off of a ventilator. Will turn off ventilation, then see how pt responds. For use to test pt before taking all the tubes out.